Readmission Review Nurse
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AI Summary
The nurse will identify and evaluate potentially preventable inpatient readmissions based on CMS definitions and company criteria. Responsibilities include communicating findings to supervisors and clients and preparing detailed written reports.
This is a remote position.
ROLE: Readmission Review Nurse
LOCATION: Remote, no travel required
TERMS: Part-time, non-exempt
SALARY: $35 - $50/hr based on experience
DRG Compliance is a division of FairCode providing DRG Validation services to health insurance plans.
The Readmission Review Nurse will collaborate with supervisor and the designated client(s)’ medical director to identify, evaluate, and present evidence of inpatient admissions and subsequent readmissions as being potentially preventable in accordance with CMS definition and DRG Compliance’s criteria set.
Responsibilities:
- Communicate timely with supervisor and client regarding review findings.
- Communicate initial findings for purposes of DRG calculations of recommended changes resulting from combining the stays for coding / payment purposes.
- Prepare written report for positive findings and communication comments on tracking sheet for negative findings.
- Monitor tracking sheet for outstanding medical records and keep supervisor informed at least every 14 days of outstanding medical records.
- Maintain current documentation of processes. Participate in other activities as assigned.
Requirements
- An RN with a minimum of 3-5 years experience in Utilization Management in a health plan or hospital setting.
- Case Management or discharge planning experience would be a plus but not required.
- Must be able to write reports to provide relevant medical record documentation and criteria-based findings.
- Excellent written and verbal communication skills, and the ability to work independently with minimal supervision.
- Working knowledge of Microsoft products such as Microsoft Word, Excel, and Outlook; however, MAC documents compatible for Microsoft conversion can be utilized.
Benefits
Remote Position: Enjoy the convenience of working from home or anywhere in the U.S.
Work-Life Balance: We encourage a healthy balance between your professional and personal life.
Work-Life Balance: We encourage a healthy balance between your professional and personal life.
Supportive Team: Join a team of dedicated professionals who value innovation, collaboration, and excellence.
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